Physical Activity for Children with Special Needs: A Call to Maintaining a Healthy Weight
By: Sabina Beckler, SPT
Overview
As the prevalence of obesity remains high in the United States and poses a threat around the world, children and adolescents are not immune to the growing epidemic. The terms overweight and obese in the pediatric population are defined as excess body weight given a particular height while taking into consideration fat percentage, muscle and bone contribution, and water component.1 According to a study by Cali et al. conducted in 2008, there are approximately 110 million children in the world who are obese or overweight.2 An estimated 16.3% of children or adolescents in the United States were classified as obese and 31.9% were considered overweight.2
The prevalence of obesity among children with additional health conditions can be even higher.3 A recent study observed children with disabilities to be significantly more likely to be overweight, obese, and severely obese compared to children without disabilities.4 In fact, 49.3% of children with disabilities in the study were overweight and 27.6% were obese.4 Unfortunately, this means that children with disabilities are also at an increased risk for developing obesity related health conditions such as hyperlipidemia, type 2 diabetes mellitus, musculoskeletal problems, respiratory issues, liver disease, psychological and social issues, and low self-esteem.4
The American Physical Therapy Association (APTA) Section on Pediatrics assembled a task force to outline the role of pediatric physical therapists in promoting health and fitness in youth with disabilities.5 Because children with disabilities are at an increased risk for being obese, physical therapists should integrate health promotion and fitness into the clinical management of children with disabilities.5 Interventions should emphasize increased participation, functional mobility, and activity levels.5
Project Development
In the fall of 2014 my PICO question in evidence-based practice II was, “In overweight or obese adolescents, is continuous aerobic exercise or high-intensity interval training more effective for weight loss?” This question helped me identify exercise interventions that are appropriate for weight loss in adolescence as well as assess the current state of evidence identifying any limitations. The final critically appraised topic (CAT) can be found here.
In addition to the CAT, I was able to design a health promotion and wellness proposal focusing on a school-based weight loss program for adolescents. This assignment allowed me to assess whether or not there is a need for weight loss programs in the community and design an evidence-based program that could be implemented. The final health promotion and wellness proposal can be found here.
The Project
The first step to building this project was to create an evidence table to answer the PICO question, “In overweight or obese children with disabilities, is exercise effective for weight loss?” This information in addition to previous projects were used to develop patient education materials for the Carolina Institute for Developmental Disabilities (CIDD) and the UNC Center for Rehabilitation Care (CRC).
One of the products is a parent brochure outlining the importance of maintaining a healthy weight and engaging in regular physical activity for children with disabilities. The brochure summarizes physical activity recommendations, lists health benefits associated with physical activity, and provides additional resources for more information.
Additionally, I created a community resource guide specifically focusing on Orange County and surrounding areas. This resource guide outlines opportunities for increasing physical activity levels in children with specials needs.
Evaluation and Reflection
Throughout the process of completing my capstone project, there were many opportunities to self-reflect and formally evaluate. Since there were a few patient education components, it was very important to assess health literacy. A summary of this process can be found here. In addition to evaluating materials for health literacy, each of my committee members provided invaluable feedback at various points throughout the development of my capstone project. Fortunately I was able to incorporate this feedback into my project and update the final products to include recommended changes. A summary of the evaluation forms can be found here.
Another product that would be a useful addition to the ones created for my capstone would be a resource for clinicians that outlines how physical therapists can screen for obesity and approach the topic of obesity with caregivers. This would be something that could be added in the future.
Acknowledgements
I would like to say a special thanks to my committee members Andrea Hartzell and Cathy Howes for ongoing support, assistance, and advice along the way. I also appreciate the support and advice offered by Catherine Wilson. Additionally, I am extremely thankful for the feedback provided by my capstone project advisor, Karen McCulloch.
References:
- Adolescent and School Health: Childhood Obesity Facts. Centers of Disease Control and Prevention Website. http://www.cdc.gov/healthyyouth/obesity/facts.htm. Published August 13, 2014. Accessed October 15, 2014.
- Cali AM, Caprio S. Obesity in children and adolescents. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S31-6. doi: 10.1210/jc.2008-1363 [doi].
- Chen AY, Kim SE, Houtrow AJ, Newacheck PW. Prevalence of obesity among children with chronic conditions. Obesity (Silver Spring). 2010;18(1):210-213. doi: 10.1038/oby.2009.185 [doi].
- Messiah SE, Vidot DC, Somarriba G, et al. Obesity and cardiometabolic disease risk factors among US adolescents with disabilities. World J Diabetes. 2015;6(1):200-207. doi: 10.4239/wjd.v6.i1.200 [doi].
- Rowland JL, Fragala-Pinkham M, Miles C, O’Neil ME. The scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities. Pediatr Phys Ther. 2015;27(1):2-15. doi: 10.1097/PEP.0000000000000098 [doi].
10 Responses to “Physical Activity for Children with Special Needs: A Call to Maintaining a Healthy Weight”
Andrea Hartzell
Hi Sabina,
Congratulations on finishing your capstone! You did a great job and it is very thorough and comprehensive. In reading some of the comments I wanted to say, yes, this can be a very sensitive topic but one I feel we as therapists need to start learning how to broach with our patients/families as it often impacts their overall mobility and health. Starting with this brochure, it can open up some communication and generate questions from families. Nice Work!
Joseph Miller
Hey Sabina,
So, I know you’ve had like 10 comments, but yours was one of the few that I printed out to read while in Guatemala.
Nice work on your capstone. I’m sure your brochure will be very beneficial to the CIDD, CRC, and the hospital. I was surprised as you were at all the different options for individuals in Orange County. I wonder if similar opportunities exist in other counties (I’m sure Orange, Wake, and Mecklenberg Counties have the most opportunities because these are the counties with the most resources). I was initially going to ask about how you could bring up the subject in the clinic, but it appears as though you have already addressed this question in your response posts (i.e. the screening tool). We have talked previously about other barriers to addressing this issue such as reimbursement. I’m glad you addressed this issue in your responses. I do have one additional question though: you mentioned a BMI calculation for determining whether a child had a healthy weight, specifically a child had an unhealthy weight if his/her BMI was greater than 95% of children the same age/sex. Given the prevalence of children being overweight in obese as you observed, do you think parents might be misled and think they their children are not among the largest 5% of children of the same age/sex?
Overall, great work. Very impressed.
Joe
Karen McCulloch
Great job on this project Sabina – I’ll be sending along the feedback form that I fill out shortly. Will wait a little longer to see if we get some feedback from Andrea about the project first though. Sounds like the trip to Guatemala was awesome. So glad you were able to participate in that!
kmac
Sabina Beckler
Hello everyone! I apologize for the delay in responding as I have been out of the country. Thank you so much for posting comments and questions on my capstone website and for taking the time to look through my project! I hope to address each of these but please feel free to ask again if I miss anything!
Jessica-You bring up some very interesting and important comments. I actually looked into implementing my health and wellness proposal in the school system as my capstone but the time commitment was a bit more than I could handle. I think it would be awesome to implement a school-based health program for children with disabilities; however, depending on the school system this may be hard to do. Sometime physical therapists are much more involved in equipment recommendations and evaluation of children in order for them to function well in the school system and less focused on overall health and wellness. The school system can be limited in this area. One way I think this could change is by developing a program in collaboration with physical education teachers or even developing an after school program that includes children with disabilities. You’re right in saying that even a little bit of exercise can really help. This is something we should be aware of and consider when working with children with disabilities. Thanks for posting!
Reid-Thank you for your feedback! I think that family plays such a big role in childhood obesity. Often it isn’t enough to place a child in a program focused on weight loss if the parents are not willing to make changes as well. Thanks for taking the time to read through my materials!
Briarly- You are too sweet! Thank you for taking the time to post feedback and offer praise on my capstone project. I am glad you found the resources helpful!
Christine- you bring up some very important points. I think there are certainly ways for PTs to be reimbursed for interventions aimed at obesity; however, I think it all depends on how we write our goals and notes. Obesity does often impact endurance and participation in various activities. Using these activities as functional goals can help justify PT interventions. For your second comment, I stumbled across a few article while reading about childhood obesity that focused on the emotional aspects of obesity particularly body image and confidence. Some of the studies included questionnaires about self confidence and body image pre and post weight loss intervention and found these to improve. There is definitely more research on those aspects of obesity available, but I did not spend a lot of my time researching that topic. Your last comment is in my opinion a very important point that I failed to comment on previously. Family is HUGE! Many of the studies I read included family education components as part of the intervention. I had the opportunity to work with one child with disabilities who was obese and wanted to lose some weight during one of my clinicals. His entire family got a gym membership and made both nutritional and physical activity changes. This patient was able to make a lifestyle change and will likely have more lastly changes. I think a family oriented exercise program would be extremely beneficial. There would be more accountability and this can contribute to a lifestyle change rather than just a short term intervention. Great comments! I do plan on staying in NC at least for a few years after graduation and hope our professional paths will cross!
Sabina
Christine Lysaght
Sabina,
Great capstone. As you state in your CAT it is unfortunate that PTs are not reimbursed for interventions aimed at obesity. However, do you think PTs can navigate these waters by justifying decreased endurance/participation in PE or community activities as the treatable impairment? Also, did any of the articles you read discuss the emotional aspects of obesity? One last comment, for my health and wellness project there was evidence linking physical activity of parents with that of their children. Do you think a family oriented exercise program would be beneficial? Obviously I am also interested in this topic:)
Great job and I hope our professional paths cross in the future. Are you staying in NC?
Briarly White
Sabina, I have great interest in your topic, and I admire the easy-to-read format and concision of your products (even evidence table!) while synthesizing a good number of resources. I appreciated your comments as well as on the articles in the evidence table such as Rowland 2015, which indeed appears a “keeper” for reference in the future. I am saving your community resource list and evidence table for future use in the clinic–wonderful resources for clinicians! The community resource list does not appear too high a reading level for parents despite how it tested (12th grade), and it is very helpful to include all contact information–makes it so easy to use! I am perhaps most impressed with the focus you have maintained on this issue of childhood obesity, building depth of knowledge through all three major projects over this third year in the program. I am coming to you for assistance when seeking answers with obese pediatric patients, with disabilities or healthy, in the future.
Thank you!
Briarly
Reid
Greetings Sabina!
Wow! Can I first say that your Capstone project is VERY comprehensive and well done. It was very neat to read through all of your materials and see how your materials built on and supported each other. From your CAT, which helped your identify exercise interventions for weight loss in adolescents, to your wellness program proposal to assess the need for community weight loss programs…you have covered your bases!
I can see how the family component of addressing obesity in children can be very challenging. I think that your parent brochure and community resource guide are effective ways to address this challenge. I too was surprised at some of the amazing resources available to children with disabilities, including the Triangle Swim School. That sounds like a great way to achieve cardiovascular benefits for this population, while being fun at the same time.
Overall, I am thoroughly impressed with your Capstone and plan on using the community guides in the future!
Jessica Skeeter
Hi Sabina,
I think your evaluation of childhood obesity is both timely and appropriate considering the current obesity epidemic among both children and adults in this country. Furthermore, the resources you have provided here on your Capstone page will definitely be useful in practice for educating parents on obesity and the importance of physical activity. The community resource guide is also extremely helpful for patients living in the Chapel Hill area, and is something I believe should be created for other communities as well to help families access physical activity opportunities that are vital for improving and maintaining overall health. Taking into consideration your health promotion and wellness proposal and the additional resources you posted here on your Capstone site, do you believe that a similar school-based program for overweight and obese children with disabilities might be feasible? Or, would this program be better suited in a different setting? In either scenario, what elements/parameters might you adjust to make such a program appropriate for children with disabilities? As you discussed, physical inactivity is clearly an issue for our patients with disabilities, as even low levels of activity can be more challenging for these individuals secondary to physical and/or cognitive deficits that may limit movement.
I agree with Bryan – you did a great job reflecting on this project and considering what aspects may be appropriate to address in the future. Overall, I believe that this is an excellent Capstone! Good luck with finishing up the rest of the semester. I’ll be seeing you in Guatemala!
Best,
Jessica
Sabina Beckler
Hi Bryan,
Thanks for taking the time to look over my Capstone! I found when creating the community resource guide that Chapel Hill has a lot to offer. I actually had to focus on the resources that were either free or relatively inexpensive because there are so many options! Unfortunately that’s not the case everywhere and it could be much harder to provide children with disabilities opportunities to engage in physical activity through adapted sports or recreation in areas that are more under served.
I actually found that one of the most challenging aspects of addressing obesity in children can be the family component. There’s a fair amount of research that supports incorporating the family in pediatric care in order to achieve changes. When it’s comes to obesity, this makes so much sense since kids can’t make healthy food choices or even go to a park without a parent’s help. So to approach the topic of obesity with parents, I have thought about the idea of using a questionnaire in which there are a few questions about the child’s weight, physical activity levels, and diet. This could allow for some additional communication about the topic. Definitely a topic that needs to be addressed and would be interesting to look into. Thanks for posting!
Sabina
Bryan Mull
Sabina,
Though the issue surrounding obesity and its negative impact on our nation’s healthcare system has been a frequent topic in our program, I am always taken aback after reading the figures on exactly how prevalent of a problem it is in our society. In reading over your Capstone page, it is apparently no less concerning with regards to the nation’s youth – one in three kids are overweight! That is a huge problem! It is important for student therapists to be well informed on this topic and have an idea of how to address it when we are out on clinicals or finally practicing as licensed clinicians. I found your community resource guide very helpful, especially since I hope to stay in this area after graduation and will inevitably encounter a patient or family who fits the population your project is focused around. I was unaware of several of the organizations on your guide, such as the Healthy Lifestyles Program At Duke and the Town of Chapel Hill Adapted Recreation. My first question to you in reading through this material was if you had any useful tips or strategies for how to approach this potentially sensitive topic with a family member or caregiver. However, it seems you did a great job self-reflecting and identifying things that could have made this even more of a great project than it already is. Great job on your Capstone! Have a great trip to Guatemala.
Thanks,
Bryan